Provider Demographics
NPI:1265437867
Name:NOVAK, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24075 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5846
Mailing Address - Country:US
Mailing Address - Phone:216-831-5700
Mailing Address - Fax:216-839-4905
Practice Address - Street 1:3401 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7344
Practice Address - Country:US
Practice Address - Phone:216-831-5700
Practice Address - Fax:216-839-4905
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH048833207W00000X
OH35-048833207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0826931Medicaid
OH000000027302OtherANTHEM
OH180030562OtherRAILROAD MEDICARE
OH0004057921OtherAETNA
OH0826931Medicaid
OHD76674Medicare UPIN